Hybrid therapy for Helicobacter pylori infection:A systemic review and meta-analysis

AIM: To compare the effectiveness of hybrid therapy with other recommended regimens using metaanalysis.METHODS: Bibliographical searches for randomized trials comparing hybrid and other therapies were performed in Pubmed, the Cochrane Library and relevant congresses up to February 2015 using the following keywords(all fields and/or me SH):("Helicobacter pylori " or "H. pylori") and("hybrid therapy" or "sequential-concomitant therapy"). metaanalyses were performed with Cochrane Review manager 5.1. The random effect model proposed by Der Simonian and Laird and the mantel-Haenszel method were used to estimate the pooled relative risk and 95%CI of the efficacy outcomes between hybrid therapy and other eradication therapies. RESULTS: Eight studies(2516 subjects) met entry criteria. The antimicrobial resistance in the study groups ranged from 6.9% to 23.5%. The mean cure rates of hybrid therapy by intention-to-treat(ITT) and perprotocol analyses were 88.5%(n = 1207; range: 80.0% to 97.4%) and 93.3%(n = 1109; range: 85.7% to99.1%), respectively. meta-analysis showed there was no significant difference in ITT eradication rate between hybrid and sequential therapy(relative risk: 1.01; 95%CI: 0.92-1.11). Subgroup analysis revealed hybrid therapy was more effective than sequential therapy in the non-Italian populations(95%CI: 1.01-1.18) and was only less effective in one, Italian population(95%CI: 0.83-0.98). There was no significant difference in eradication rate between hybrid therapy and concomitant therapy(95%CI: 0.93-1.02). No head-tohead comparisons of hybrid therapy and standard triple therapy or bismuth quadruple therapy were found. However, a multicenter, randomized trial showed that reverse hybrid therapy was superior to standard triple therapy(95.5% vs 88.6% ITT; P = 0.011).CONCLUSION: Hybrid therapy appears to be an effective, safe, and well-tolerated treatment for H. pylori infection in the era of increasing antibiotic resistance.

Hybrid, sequential and concomitant therapies for Helicobacter pylori eradication: A systematic review and meta-analysis

AIM: To compare hybrid therapy(HT) with traditional sequential therapy(ST) and concomitant therapy(CT) for Helicobacter pylori(H. pylori) eradication.METHODS: We performed an electronic search of Pub Med, Embase, and the CENTRAL database. Randomized controlled trials(RCTs) of HT were included in the meta-analysis. The primary outcome was the eradication rate of H. pylori. The secondary outcomes included the compliance rate and adverse event rate. Effect estimates were pooled using the random-effects model.RESULTS: Twelve studies were included. Pooled results showed no significant differences in eradication rate between HT and ST in per-protocol(PP) analysis(RR = 1.03, 95%CI: 0.94-1.12, P = 0.59) or in intention-totreat(ITT) analysis(RR = 1.00, 95%CI: 0.89-1.12, P = 0.94). HT and ST showed similarly high compliance rate(96% vs 98%, P = 0.55) and acceptable adverse event rate(30.3% vs 28.2%, P = 0.63). No significant results were seen in the eradication rate between HT and CT in PP analysis(RR = 1.01, 95%CI: 0.96-1.05, P = 0.76) or in ITT analysis(RR = 0.99, 95%CI: 0.95-1.03, P = 0.47). HT displayed a slightly higher compliance rate than CT(95.8% vs 93.2%, P < 0.05). The adverse event rates of HT and CT were similar(39.5% vs 44.2%, P = 0.24).CONCLUSION: Compared with ST or CT, HT yields a similar eradication rate, high compliance rate, and acceptable safety profiles.

Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: a prospective randomized trial

AIM: To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori(H. pylori) infection.METHODS: From March 2013 to May 2014,one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before wererandomized to receive either sequential therapy(rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d,followed by rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy(rabeprazole 20 mg and amoxicillin 1 g for 7 d,followed by rabeprazole 20 mg,amoxicillin 1 g,clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy,or 13C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intension-to-treat(ITT) and per-protocol(PP) analyses.RESULTS: One hundred and sixty-seven patients(83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups,respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis(P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis(P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid group.CONCLUSION: Due to a grade A(> 95%) success rate for H. pylori eradication by PP analysis,similar compliance and adverse events,hybrid therapy seems to be an appropriate eradication regimen in Taiwan.

CYP2C19 polymorphism has no influence on rabeprazole-based hybrid therapy for Helicobacter pylori eradication

AIM To evaluate the impact of cytochrome P450 2C19(CYP2C19) and interleukin-1β(IL-1β) polymorphisms on the efficacy of Helicobacter pylori(H. pylori) eradication by using rabeprazole-based hybrid therapy.METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13 C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94%(79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers(EM) and 95.83% in non-EM. The H.pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori.CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H.pylori eradication using rabeprazole-based hybrid therapy.

Targeting Hypoxic Tumors with Hybrid Nanobullets for Oxygen-Independent Synergistic Photothermal and Thermodynamic Therapy

Hypoxia is a feature of solid tumors and it hinders the therapeutic efficacy of oxygen-dependent cancer treatment.Herein,we have developed all-organic oxygen-independent hybrid nanobullets ZPA@HA-ACVA-AZ for the“precise strike”of hypoxic tumors through the dual-targeting effects from surface-modified hyaluronic acid(HA)and hypoxia-dependent factor carbonic anhydrase IX(CA IX)-inhibitor acetazolamide(AZ).The core of nanobullets is the special zinc(II)phthalocyanine aggregates(ZPA)which could heat the tumor tissues upon 808-nm laser irradiation for photothermal therapy(PTT),along with the alkyl chain-functionalized thermally decomposable radical initiator ACVA-HDA on the side chain of HA for providing oxygen-independent alkyl radicals for ablating hypoxic cancer cells by thermodynamic therapy(TDT).The results provide important evidence that the combination of reverse hypoxia hallmarks CA IX as targets for inhibition by AZ and synergistic PTT/TDT possess incomparable therapeutic advantages over traditional(reactive oxygen species(ROS)-mediated)cancer treatment for suppressing the growth of both hypoxic tumors and their metastasis.

Perceived Stress and Coping Strategies in Entry-Level Doctor of Physical Therapy Students Enrolled in a Hybrid-Learning Curriculum during the Pandemic

Physical therapy students can experience elevated levels of stress due to the pressure to be successful, changes in the environment, personal concerns, the lack of spare time, increased work, or financial burdens. The purpose of this study was to examine the perceived stress and coping strategies of Doctor of Physical Therapy (DPT) students enrolled in a hybrid-learning curriculum during the COVID-19 pademic. A total of 73 students enrolled in the DPT hybrid-learning curriculum responded to a survey which consisted of socio-demographics, the 10-item Perceived Stress Scale (PSS), and the 28-item Brief COPE. A general question regarding stress relating to COVID-19 was presented as a sliding percentage. Data analysis included a Spearman correlation, a Kruskal-Wallis test, and a linear regression to evaluate coping mechanisms against PSS scores. The mean (± SD) score on the PSS was 22.65 (± 10.21) and the Brief COPE was 59.18 (± 10.61). A non-significant negative correlation was found between the PSS and Brief COPE (r = -0.024). A third of the variation in the perceived stress score could be accounted for by students utilizing coping mechanisms regardless of other factors (R2 = 0.35). No significant differences were found when comparing PSS and Brief Cope to age, hours worked per week and term. Perceived stress was higher in females compared to males, but the results were not significant. Stress related to COVID-19 mean percentage reported by DPT students was 49.03%. During a global pandemic, DPT students enrolled in a hybrid-learning curriculum reported elevated levels of stress but reported higher adaptive versus maladaptive coping strategies. It can be beneficial that universities evaluate the stress and coping methods of students to potentially avoid the negative impacts of stress.

Hybrid手术镶嵌治疗儿童法洛四联症

目的探讨Hybrid手术镶嵌治疗儿童法洛四联症（TOF）的效果。方法术前介入治疗：3例有巨大体肺侧支（APCAs）的重症TOF在根治术前予以侧支血管堵塞术，其中2例采用国产动脉导管未闭封堵器堵闭体肺侧支血管，1例采用可控弹簧圈栓塞体肺侧支血管。术后镶嵌治疗：6例TOF根治术后残余分流，包括4例残余膜周部室间隔缺损（VSD），1例残余左室右房通道VSD，1例残余房间隔缺损（ASD）。对于VSD，首先建立动-静脉轨道，选择较缺损直径大2mm的VSD封堵器，在超声心动图引导下将封堵器放置正确位置后释放封堵器；对于ASD，经股静脉置入鞘管至左心房，在超声心动图引导下将大小合适的ASD封堵器放置到位后释放封堵器。结果3例有巨大APCAs的重症TOF在根治术前予以侧支血管堵塞术后随即行外科手术，术后肺血明显减少，灌注肺症状消失，术程顺利，皆获得满意效果。随访1，5～2．0a患儿发育正常。6例TOF根治术后残余分流者经导管封堵术封堵成功，心脏杂音消失。随访1～3a无残余分流及心脏瓣膜异常，未出现心律失常，患儿生长发育良好。结论Hybrid手术治疗伴巨大APCAs及术后存在残余分流的TOF安全、有效。

杂合式血液净化序贯疗法与丹参注射液联合治疗重症急性胰腺炎的效果分析

目的分析杂合式血液净化序贯疗法与丹参注射液联合治疗重症急性胰腺炎(SAP)的效果。方法98例SAP患者,使用随机数字表法分为对照组(49例)与研究组(49例)。两组均接受基础治疗,对照组应用杂合式血液净化序贯疗法,研究组在其基础上联合丹参注射液治疗。比较两组患者的临床疗效、症状与体征改善时间、不良反应发生情况。结果研究组患者总有效率95.92%高于对照组的81.63%(P<0.05)。研究组腹痛腹胀消失时间、血尿淀粉酶恢复正常时间、尿恢复正常时间、体温恢复正常时间分别为(4.23±0.95)、(4.15±1.06)、(6.00±0.92)、(5.02±0.85)d,均短于对照组的(6.00±0.86)、(6.45±1.09)、(7.56±1.00)、(6.50±0.79)d(P<0.05)。两组不良反应发生率比较未见差异性(P>0.05)。结论杂合式血液净化序贯疗法与丹参注射液联合治疗SAP效果确切,能够促进患者症状与体征恢复,具有临床推广价值。

乳腺癌患者螺旋断层放疗与混合调强放疗治疗效果探讨

目的探讨螺旋断层放射治疗(helical tomotherapy,TomoHelical)与混合调强放射治疗(hybrid intensity modulated radio-therapy,Hy-IMRT)2种治疗方式对早期乳腺癌保乳手术患者的影响。方法随机选取厦门大学附属第一医院肿瘤放射治疗科2023年1—7月保乳乳腺癌手术早期患者50例,并按术后射线治疗方式的不同分为TOMO组与Hy-IMRT组,各25例。比较2种治疗方式照射靶区处处方剂量(planning target volume,PTV)的剂量学参数及放疗后周围正常器官剂量学,放疗结束随访3个月并比较其预后情况。结果与Hy-IMRT相比,TOMO治疗的PTV符合性指数(conformity index,CI)为(0.68±0.15),均匀性指数(homogeneity index,HI)为(1.09±0.12),Hy-IMRT治疗治疗的PTV CI为(0.54±0.12),HI为(1.37±0.17),差异有统计学意义(P<0.05)。TOMO组全肺平均放射剂量(mean does,Dmean)为(517.23±109.33)cGy,全肺受到5 Gy或以上的辐射剂量的体积百分比(volume5,V5)为(18.53±4.07)%,全肺受到20 Gy或以上的辐射剂量的体积百分比(volume20,V20)为(10.55±2.83)%,Hy-IMRT组全肺平均放射剂量(mean does,Dmean)为(581.12±113.72)cGy,全肺受到5 Gy或以上的辐射剂量的体积百分比(volume5,V5)为(21.44±4.85)%,及全肺受到20 Gy或以上的辐射剂量的体积百分比(volume20,V20)为(12.66±3.15)%,TOMO组均低于Hy-IMRT组(P<0.05)。TOMO组心脏Dmean为(521.44±86.72)cGy,Hy-IMRT组心脏Dmean为(577.14±96.33)cGy,TOMO组低于Hy-IMRT组(P<0.05)。结论对早期乳腺癌保乳手术患者实施TOMO计划治疗,可以有效提升肿瘤靶区剂量分布的均匀性,对周围正常组织器官损害较小,但仍需更多临床数据来支持。

成人右室双出口Hybrid手术前后封堵术疗效的比较

目的:总结Hybrid手术镶嵌治疗成人右室双出口并发右室流出道狭窄的疗效。方法:对21例成人右室双出口右室流出道狭窄并发侧支血管患者进行根治手术和侧支血管封堵手术。将患者分成两组,一组为侧支血管封堵后行外科根治手术,另一组为行外科根治手术后进行侧支血管封堵术。结果:12例患者在根治手术前行侧支血管封堵术,所有患者术后恢复顺利,痊愈出院,1例患者术后出现严重咯血再次行支气管动脉封堵术。9例在根治术后行侧支封堵术,术后患者呼吸机使用时间长,住ICU时间长,死亡1例。结论:外科手术前封堵侧支血管较术后封堵效果好。

Hybrid技术治疗心脏复杂畸形合并肌部室间隔缺损的临床观察

目的探讨Hybrid技术在治疗儿童心脏复杂畸形合并肌部室间隔缺损(m VSD)的疗效。方法回顾性分析2010年12月—2016年12月我院收治的18例(男9例,女9例)复杂心脏畸形伴m VSD患儿的临床资料。复杂心脏畸形主要包括:法洛氏四联征、主动脉弓缩窄、完全性大动脉转位、右心室双出口、二尖瓣裂等。全组均在体外循环心内直视下行复杂畸形Ⅰ期解剖矫治及镶嵌封堵术。结果术后4例患者死亡,1例因术后感染,1例因复杂畸形未能修复,1例因封堵器移位致二尖瓣损伤,1例因不明原因心律失常。1例由于存在巨大膜部室间隔缺损行Ⅰ期手术时未发现肌部室缺,行非计划再次手术。余患儿均完成Ⅰ期手术矫治后顺利出院。随访(1个月~5年)无死亡。14例患儿中14例封堵器位置良好,12例无明显残余分流,13例心功能正常(射血分数0.63±0.05)。结论Hybrid治疗m VSD安全、有效,尤其适用于合并其他心内、外复杂畸形的患儿或复杂血管情况的患者。

A new look at anti-Helicobacter pylori therapy

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.

左侧乳腺癌保乳术后深吸气屏气模式下Hybrid-IMRT和Hybrid-VMAT的剂量学比较

目的:在深吸气屏气(DIBH)模式下比较适形混合调强(Hybrid-IMRT)和适形混合旋转容积调强(Hybrid-VMAT)对左侧乳腺癌保乳术后的剂量学差异,为治疗计划选择提供参考。方法:选取26名左侧乳腺癌保乳术后的患者分别设计Hybrid-IMRT和Hybrid-VMAT计划,通过体积剂量直方图比较两种计划的靶区和危及器官的剂量。结果:Hybrid-VMAT计划PTV的D90、D98及HI优于Hybrid-IMRT计划(P<0.05)。Hybrid-IMRT计划GI优于Hybrid-VMAT计划(P<0.05),但对于PTV的D2、D_(mean)及CI,两种计划没有明显差异(P>0.05)。Hybrid-IMRT计划患侧肺V_(5)、V_(20)、V_(30)及D_(mean)优于Hybrid-VMAT计划(P<0.05);Hybrid-IMRT计划心脏的V_(10)、D_(mean)优于Hybrid-VMAT计划(P<0.05),但V_(30)、V_(40)比较,差异无统计学意义(P>0.05);Hybrid-IMRT计划对侧乳腺D_(mean)、V_(5)优于Hybrid-VMAT计划(P<0.05),但D_(max)比较,差异无统计学意义(P>0.05);两种计划的脊髓剂量均满足临床剂量要求,但Hybrid-IMRT计划的脊髓D_(max)低于Hybrid-VMAT计划(P<0.05)。结论:两种混合计划均能满足临床剂量要求,但Hybrid-IMRT计划可以明显降低危及器官的受照剂量。

Helicobacter pylori:Future perspectives in therapy reflecting three decades of experience

The rising prevalence of antibiotic resistance has created a need to reassess the established Helicobacter pylori(H.pylori)eradication protocols,and to develop new ones.Various bacterial and host factors are evaluated,and their contribution to eradication failure is estimated.For a long time being considered the cornerstone eradication scheme,the standard triple therapy has been replaced with novel,more efficient regimens,namely sequential and concomitant,along with the emergence of a new design of bismuth quadruple therapy.A rescue levofloxacin based regimen has overcome the fear of therapy failure due to higher prevalence of dual resistant(clarithromycin and metronidazole)H.pylori.Culture-free and efficient susceptibility test are reestablishing the concept of tailored therapy,making eradication success close to originally desirable rates.Alleviating therapy side effects and improving patient compliance are as important as choosing appropriate eradication schemes,so various probiotic compound supplements are taken into consideration.Finally,we summarize the emerging efforts and obstacles in creating efficientH.pylori vaccine.

弓部受累的主动脉疾病治疗应用进展

弓部受累的主动脉疾病治疗方案的选择较多,包括外科手术、血管腔内修复以及杂交手术治疗。外科手术行主动脉弓置换,手术创伤相对较大;行血管腔内修复,存在锚定区不足的问题,需重建主动脉弓分支血管;杂交手术能扩展锚定区,增加腔内修复的适应证。现就各种方法的优缺点进行简述。

The Therapeutic Effectiveness of Hybrid Renal Replacement (HRRT) in Patients with Severe Snakebite

Objective:To investigate the therapeutic effects of hybrid renal replacement therapy (HRRT) in patients with severe snake bite. Methods: 15 patients treated with HRRT from July in 2005 to August in 2009 were involved in the study, all patients were established ascular access by central venous catheter, polysulfone membrane connected absorption hemoperfusion cartridge, the blood flow rate was 200 ml/min, the dialysate flow rate was 300 ml/min, heparin or low molecular heparin was used as anticoagulant, treatment time was 6 to 12 hours. Observe the biochemical indicators and APACHE II score before and after HRRT and clinical outcomes of the patients. Results: The level of serum creatinine, glutamic-oxalacetic transaminease, glutamic-pyruvic transaminease, creatine kinase isozyme MB, and creatine kinase were significantly lower than the level before HRRT(P<0.05); the level of cholinesterase was significantly higher than the level before HRRT (P<0.01); the APACHE II score before HRRT was 14.1±3.8, but decreased significantly to 7.9±1.4, 6.2±1.1 and 4.2±0.8 at the first, second and seventh day after HRRT, respectively (P<0.01). There are 3 patients died at the first, third, and fourth HRRT, respectively, the rest 12 patients were cured or improved when discharged, the survival rate was 80%, and the mortality was 20%. Conclusion: HRRT may be an effective treatment method for severe snake bite patients, which can reduce the mortality rate and increase the survival rate.

Trojan nanobacteria hybridized with prodrug nanocapsules for efficient combined tumor therapy

Live bacteria-based drug delivery systems have been raised as promising tools for enhancing drug delivery into tumors due to their active tumor targeting and easy surface modifiability.In this work,a“Trojan nanobacteria hybrid”,E.coli@highly integrated nanocapsules(HINCs)hybrid(HINE-Hybrid),was successfully constructed with HINCs of prodrug based on covalent selfassembly and the facultative anaerobic bacterium E.coli MG 1655 for combined chemotherapy,photothermal therapy(PTT),and chemodynamic therapy(CDT).HINCs were constructed by covalent cross-linking of pillar[5]arene derivatives and cisplatin prodrug linker,which can be endocytosed and lysed to release therapeutic agents.Under the near-infrared(NIR)light(at 808 nm)irradiation,the system temperature can be significantly increased by HINCs,which further leads to the highly efficient generation of reactive oxygen species(ROS).In addition,HINE-Hybrid shows significant antitumor effects in in vitro and in vivo studies and also promotes immune cell infiltration and antitumor cytokine expression in the tumor microenvironment(TME).HINEHybrid exerts its anticancer properties efficiently due to selective enrichment and multiplication of E.coli at tumor sites,which is important for the construction of bacterial-assisted antitumor platforms.

黑色素基靶向纳米药物用于乳腺癌的光热治疗

为提高小尺寸黑色素纳米颗粒(MNP)在肿瘤部位的靶向效应,设计合成了一种在肿瘤微酸性环境下可降解的羟基磷灰石杂化介孔氧化硅(MSN/HAP)对其进行负载,结合RGD导向肽构建了一种新型靶向纳米药物(MAN/HAP-MNP-RGD),用于小鼠乳腺癌的多模态成像和光热治疗.对纳米颗粒进行了理化性能、细胞和活体实验.结果表明,颗粒尺寸约为60 nm,MNP的负载量为37.7%,在微酸性环境中呈现较好的降解性,且纳米颗粒的光热转化效率(η)高达40.29%.细胞实验结果也证明了纳米颗粒的高效摄取和对细胞的光热杀伤效果.此外,光声成像和磁共振成像结果表明,纳米颗粒在肿瘤部位表现出更高的累积和更长时间的滞留.活体实验结果证明,MAN/HAP-MNP-RGD具有最佳的治疗效果且具有很高的生物安全性,展现出潜在的应用前景.

A coating strategy on titanium implants with enhanced photodynamic therapy and CO-based gas therapy for bacterial killing and inflammation regulation

Antimicrobial photodynamic therapy(aPDT)has been considered a noninvasive and effective modality against the bacterial infection of peri‑implantitis,especially the aPDT triggered by near-infrared(NIR)light due to the large penetration depth in tissue.However,the complexity of hypoxia microenvironments and the distance of aPDT sterilization still pose challenges before realizing the aPDT clinical application.Due to the long lifespan and transmission distance of therapeutic gas molecules,we design a multi-functional gas generator that combines aPDT as well as O_(2) and CO gas release function,which can solve the problem of hypoxia(O_(2))in PDT and the problem of inflammation regulation(CO)in the distal part of peri‑implant inflammation under near-infrared(NIR)irradiation.In the composite nanoplatform that spin-coated on the surface of titanium implants,up-conversion nanoparticles(UCNPs)were involved in converting the NIR to visible,which further excites the partially oxidized stannic sulfide(SnS_(2)),realizing the therapeutic gas release.Indocyanine green(ICG)was further integrated to enhance the aPDT performance(Ti-U@SnS_(2)/I).Therefore,reactive oxygen species(ROS),CO,and O_(2) can be controllably administered via a composite nano-platform mediated by a single NIR light(808 nm).This implant surface modification strategy could achieve great self-enhancement antibacterial effectiveness and regulate the lingering questions,such as relieving the anoxic microenvironment and reaching deep infection sites,providing a viable antibiotic-free technique to combat peri‑implantitis.

脊柱转移瘤分离手术联合立体定向放疗的研究进展

随着癌症治疗水平的不断提升,脊柱转移瘤患者的生存期得到显著延长。当前脊柱转移瘤的治疗呈现多模式趋势,临床采用的手术方式包括椎体肿瘤切除椎管减压重建内固定术、分离手术、微创手术和经皮消融技术等,放疗技术包括传统外照射治疗、立体定向放疗和近距离放疗等。椎体肿瘤切除椎管减压重建内固定术的手术风险较大,术中和术后并发症的发生率较高,术后恢复期的延长可能造成后续放疗和其他内科治疗的延误,对患者的生存期和治疗信心都造成严重影响。而传统外照射治疗的精准度不高,脊髓耐受性的限制使得放疗剂量常难以达到控制放疗不敏感肿瘤的目的。随着放疗和手术技术的发展,精准性更高的立体定向放疗和手术创伤更小的分离手术脱颖而出,成为目前临床医生关注的焦点。本文就分离手术联合立体定向放疗的Hybrid治疗的研究进展作一综述。